Title: A Comparative Study of two Doses of Intrathecal Clonidine with Hyperbaric Bupivacaine in Elective Lower Abdominal and Lower Limb Surgeries

Authors: Dr Santhosh. T, Prof Dr C.S.Prakash

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i10.162

Abstract

Introduction: For lower limb and lower abdominal surgeries, the standard anaesthetic technique is subarachnoid block. Adrenaline being the first spinal adjuvant used to increase the duration and to reduce the toxicity of spinal anaesthesia in 1903. From then on many drugs have been tried in search for an ideal adjuvant. They are opioids, sodium bicarbonate, ketamine, neostigmine, midazolam and the latest inclusion is clonidine.

Aim: To study the effects of adding two doses of clonidine (30 and 45 mcg) to 12.5 mg hyperbaric bupivacaine in lower abdominal and lower limb surgeries. Sensory and motor parameters and analgesia were monitored.

Materials and Methods: After getting the ethical committee approval the study was conducted in 90 patients undergoing elective lower abdominal and lower limb surgeries in Rajah Muthiah Medical College and Hospital, Chidambaram. It was a double blinded study in which patients were randomly allocated into 3 groups I, II and III. Group I received only intrathecal bupivacaine 2.5mg. Group II received bupicaine 2.5mg + clonidine 30µg. Group III received bupivacaine 2.5mg + clonidine 45µg. Sensory and motor parameters and analgesia were monitored along with the vitals of the patient.

Results and Conclusion: This study shows that adding 45µg of clonidine significantly results in more duration of post operative analgesia than adding 30µg of clonidine to bupivacaine and bupivacaine alone without any side effects.

Keywords: Intrathecal clonidine, spinal adjuvant, additives to bupivacaine

References

  1. Anil Thakur et al. Intrathecal Clonidine as an adjuvant to Hyperbaric Bupivacaine in patients undergoing Inguinal Herrmior-aphy - A randomised bouble blinded study. Journal of Anaesthesiology Clinical Pharmacology 2013 - 29(1): 66-70.
  2. BS Sethi, Mary Samuel, Deepak Shreevatsava. Efficacy of Analgesic effects of low dose Clonidine as an adjuvant to Hyperbaric Bupivacaine. Indian Journal of Anaesthesia 2007 - Mar - 29 (1) : 66-70.
  3. Dr Birbal Baj et al. Intrathecal Clonidine as an adjuvant to Hyperbaric Bupivacaine in patients undergoing surgeries under spinal anaesthesia - A randomised bouble blinded study. IOSR Journal of Dental and Medical Sciences 2015 - Sep.
  4. Raj Bahadur Singh, Neetu Chopra et al. Role of Intrathecal Clonidine as an adjuvant to Hyperbaric Bupivacaine in patients undergoing lower abdominal surgeries - A randomised bouble blinded study. Anaesthesia Essays and Researches. 2014 - Oct: 307-12.
  5. N Ratan Singh et al. Effect of Intrathecal Clonidine as an adjuvant to Hyperbaric Bupivacaine in patients undergoing caesarean section. International Journal of Health Sciences and Research. 2014: 5(1): 100-105.
  6. Dobrydnjov i et al. Clonidine combined with small dose bupivacaine for inguinal hernia surgery. Anaes analg., 2003;96;1496-503.
  7. Bonnet et al, spinal clonidine as an adjuvant with hyperbaric bupivacaine in orthopaedic surgeries., British journal of anaesthesia,1989; 63;1;93-96.
  8. Fogarty et al, spinal clonidine vs morphine with bupivacaine in patients undergoing total hip replacement surgeries., British journal of anaesthesia, 1993;71;5;661-64.
  9. Grace et al, co administration of pethidine and clonidine in spinal anaesthesia for total hip replacement surgeries., British journal of anaesthesia., 1994; 73 ;5;628-33.
  10. Pan et al, comparison of analgesic effects of intrathecal neostigmine vs clonidine with bupivacaine in caesarean section., regional anaesthesia and pain medicine, 1998; 23; 1; 49-56.
  11. Monica brunschwiller et al, comparison of intraoperative anaesthetic and haemodynamic effects of clonidine-bupivacaine, morphine-bupivacaine and placebo-bupivacaine combinations during continuous spinal anaesthesia in knee replacement surgeries., canadian journal of anaesthesia, 1998;45;8;    735-40.
  12. j.siddall et al, comparison of efficacy of intrathecal Morphine and Clonidine in the treatment of Pain After Spinal Cord Injury., anaesthesia analgesia., 2000;91;1493-1498.

Corresponding Author

Dr Santhosh. T

Post Graduate Student, Dept of Anaesthesia,

Rajah Muthiah Medical College and Hospital,

Chidambaram, Tamil Nadu, India